Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

Objective To analyze and assess the postoperative motor function in children with spastic cerebral palsy (SCP) by surface electromyography (sEMG) and joint angle. Methods Sixteen children with SCP were involved in this study. The sEMG of rectus femoris, biceps femoris, semitendinosus, tibialis anterior, lateral gastrocnemius and medial gastrocnemius muscles and joint angles of the hip, knee and ankle during straight walking were collected preoperatively and postoperatively. In every gait phase, the mean values of joint angles, root mean square and integrated electromyography of sEMG were calculated, to evaluate muscle strength and muscular tension quantitatively. Results The muscle tension of lower limbs was significantly decreased (P<0.05). The muscle strength of rectus femoris and biceps femoris was decreased in the swing phase. At the midswing and terminal swing phase, the strength of tibialis anterior increased significantly (P<0.05). The flexion angle of hip and knee decreased significantly (P<0.05). The dorsiflexion angle of ankle increased significantly (P<0.05), and the varus angle decreased significantly (P<0.05). Conclusions After operation, the crouching gait and clubfoot were improved positively. Therefore, the motor function of children was improved. Combining sEMG and joint angle can evaluate the muscle function of patients quantitatively, and it also can provide references for clinical diagnosis.

Objective:To analyze the satisfaction of referral patients for the medical services provided by the countywide medical community, for reference in further improving its quality and continuity of medical services.Methods:From April to July 2021, a systematic sampling method was adopted to selected the survey subjects from the outpatients from the leading hospitals and three affiliated units of two medical communities, as well as those from two county-level hospitals of non medical communities and five grass-roots medical and health institutions. A total of 660 patients were included in the questionnaire survey. The questionnaire covered key demographic information and 15 satisfaction questions under 4 dimensions. The propensity score matching method was used to reduce confounding factors, factor analysis was used to calculate the satisfaction of referral patients in the medical community group and the non-medical community group, and the systematic dynamics approach was used to analyze the effect of patient satisfaction on referral intention.Results:A total of 641 valid questionnaires were collected. Based on a 1∶2 propensity score matching, 591 patients were finally enrolled, consisting of 102 up-referral cases from the non-community group and 273 such cases from the community group, as well as 76 down-referral cases from the non-community group and 140 such cases from the community group. The overall satisfaction scores by both up and down referral patients were 4.26(1.01)and 4.29(1.14)respectively.The overall satisfaction, medical service satisfaction, technical service quality satisfaction and non-technical service quality satisfaction of up-referral patients, as well as the overall satisfaction, non-technical service quality satisfaction of down-referral patients of the community group were higher than those from the non-community group, with differences statistically significant( P<0.05). The higher satisfaction of patients with their referral in the community, the stronger their referral willingness. Conclusions:The overall satisfaction of refrerral patients in the medical community group is higher than that of the non medical community group. The construction of county medical community has promoted the improvement of satisfaction of referral patients. However, it is still imperative to encourage high-quality medical resources to support primary institutions, to enhance the service level of primary medical and health institutions, to implement differentiated medical insurance reimbursement policies, and to improve the continuity of medical services within the community.

A software and hardware platform for gait simulation and system evaluation for lower limb intelligent prosthesis is proposed and designed, in order that the wearable symmetry effect of the intelligent knee prosthesis can be quantitatively analyzed by machine test instead of human wear test. The whole-body three-dimensional gait and motion analysis system instrument, a device to collect gait data such as joint angle and stride of adults, was used for extracting simulated gait characteristic curve. Then, the gait curve was fitted based on the corresponding joint to verify the feasibility of the test platform in the experiment. Finally, the developed artificial knee prosthesis was worn on the prosthetic evaluation system to quantitatively analyze the gait symmetry effect. The results showed that there was no significant difference in gait symmetry between the developed knee joints at different speeds, which could reach more than 88%. The simulation and evaluation of the prosthetic gait have good effects on the functional simulation and evaluation of the lower limb intelligent prosthesis.
Adult ; Artificial Limbs ; Biomechanical Phenomena ; Gait ; Humans ; Knee Joint ; Knee Prosthesis ; Prosthesis Design

Coupling of ubiquitin conjugation to estrogen receptor degradation (CUE) domain containing protein, a newly discovered ubiquitin binding protein that contains CUE domain, plays an important role in the tumor formation, metastasis and drug resistance. Some researches have showed that CUE domain-containing protein 1 (CUEDC1) is associated with tumor lymphatic metastasis, and CUE domain-containing protein 2 (CUEDC2) is involved in the occurrence and development of solid tumors and leukemia by regulating cell cycle and signaling pathway activity. This review summarizes the CUE domain containing protein structure and the functions in the occurrence, progression, metastasis and drug-resistance of solid tumors and leukemia.

Objective To carry out a research of terrain recognition on intelligent knee joint from the perspective of pure visual information.Methods The whole experimental environment was illuminated by halogen lamp, which made the brightness and color temperature of the set scene change less. The machine vision module was embedded in the intelligent knee joint control system. The road image data was collected by the camera in real time, and the captured image was processed in grayscale. The normalized cross correlation algorithm (NCC) was used to match the image pattern to identify the corresponding road conditions.Results The accuracy rates of the road vision, up/down hill, and up/down stairs recognized by the machine vision module were 88.6%, 85.3%, 78.4%, 87.5%, and 77.9%, respectively. The recognition effect was good, and the recognition time was within one second, real-time performance was strong.Conclusion The effectiveness and feasibility of intelligent knee joint prosthetic road condition recognition based on pure visual information is proved.

Objective To investigate the the operative time of two stage soft ureteroscope lithotripsy for hemorrhagic embolism after percutaneous nephrolithotomy(PCNL).Methods The clinical data of 1 patient with massive hemorrhage after PCNL who treated with superselective renal artery embolization and ureteral soft lens were analyzed.Results The patient with postoperative bleeding after PCNL was treated with superselective renal artery branch embolization,after 30d embolization,the holmium laser lithotripsy under the soft ureteroscope for ureteral calculi was performed,and the renal pelvis mucosa smooth,no bleeding and scar formation were intraoperative visible.After operation,the stone was removed basically,and the double J tube was removed 2 weeks after operation.The patient had no special discomfort and the renal function was normal.Conclusion Postoperative 14-30d is a relatively safe time to perform flexible ureteroscopic lithotripsy for super selective renal artery embolization in the treatment of patient with massive hemorrhage after PCNL.

BACKGROUND:Signal transducer and activator of transcription 3 (STAT3) is an important cytokine signaling pathway, which plays an important role in inflammatory diseases. However, it is unclear whether gene polymorphism of STAT3 is associated with rheumatoid arthritis in the Chinese Han population. OBJECTIVE: To explore the association of gene polymorphism of STAT3 with rheumatoid arthritis in the Chinese Han population. METHODS:Four tag-single-nucleotide polymorphisms (tag-SNPs) in STAT3 were selected from the Chinese Han population of HapMap database. The study was performed with 228 rheumatoid arthritis cases and 228 normal controls. Four tag-SNPs (rs12601982, rs2293152, rs8078731 and rs9912773) were examined by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. RESULTS AND CONCLUSION:The frequency of GG genotype at rs9912773 was 18.9% and 10.5% respectively in rheumatoid arthritis and control groups, and there was a significant difference between the two groups (P < 0.05). These results indicate the possible association between the STAT3 gene polymorphism at rs9912773 and the susceptibility of rheumatoid arthritis in the Chinese Han population.

Objective To investigate the associations of variants in signal transducer and activator of transcription 4 (STAT4) in Chinese Han population with rheumatoid arthritis (RA). Methods The study was performed in 228 RA cases and 228 controls. Haplotypes from the HapMap database Chinese population were used to select tag-single-nucleotide polymorphisms (SNPs) (r2=0.9) in STAT4 gene. Twenty-three SNPs located in STAT4 gene were examined by multiplex polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The Hardy-Weinberg equilibrium (HWE) was tested by a chi-square and Fisherˊs analysis. Differences in genotypes of the STAT4 polymorphism variants were evaluated using a Chi-square test. All statistical analyses were done with Haploview 4.1 software. Results Significant difference was detected in three SNPs (rs11685878, rs129888 and rs16833437) in allele frequencies analysis (χ2=6.014 8, 4.024 8, 5.539 1, P<0.05). Association was detected for three SNPs (rs11685878, rs16833437 and rs12988825) in genotype analysis ( χ2=6.814 9, 6.098 7, 6.691 7, P<0.05). Conclusion STAT4 may associate with susceptibility in Chinese Han population.

Objective To discuss the intervention effects and mechanisms for Rapamycin on renal interstitial fibrosis in rats.Methods A total of 72 Wistar male rats were randomly divided into 3 groups,normal group(n =24) ,model group(n =24), treatment group (n =24).The model group and treatment group received adenine 200 mg/kg daily,and the treatment group was also given Rapamycin 5 mg/(kg·d) at the 8th day,the normal group was just given the same amount of normal saline for 6 weeks.In the end of the 2nd,4th and 6th week,8 rats in each group were sacrificed respectively.The expression of hepatocyte growth factor(HGF), transforming growth factor-β (TGF-β) and neutrophils gelatinases related apolipoprotein (NGAL) in each group were observed.The software of image analysis system was used for semi-quantitative analysis.Results HE and Masson staining results showed that the renal tubular were progressive swelling, and changed with interstitial fibrosis,atrophy and even necrosis in model group from 2 weeks to 6 weeks.The pathological changes of kidney were more ease in the treatment group compared with those in model group.Immunohistochemical staining results showed that HGF expression levels of renal interstitial tissue in model group and treatment group at the 2nd week were significantly higher than those of normal group(P ＜0.05), and were significantly decreased at the 4th week and 6th week (P ＜ 0.05);HGF expression levels of renal interstitial tissue in treatment group were significantly higher than those in model group (P ＜ 0.05).NGAL expression levels of renal interstitial tissue in model group and treatment group at the 2nd week were significantly higher than those in normal group(P ＜0.05) ,and were significantly decreased at the 4th week and 6th week(P ＜ 0.05);NGAL expression levels of renal interstitial tissue in treatment group were significantly higher than those in model group (P ＜ 0.05).TGF-β expression levels of renal interstitial tissue in model group and treatment group at the 2nd,4th,and 6th week were significantly higher than those in normal group (P ＜0.05) ,while TGF-β expression levels of renal interstitial tissue in treatment group were significantly lower than those in model group (P ＜ 0.05).Conclusion Rapamycin could improve the rat kidney tissue pathology, relieve renal tubular expansion, and slow progression of renal interstitial fibrosis, and has certain protective effect to the kidney.